ACOs Without the Rules: Private Sector Offers Route to Reform

This has been an interesting week for the much maligned federal Patient Protection and Affordable Care Act (ACA). Early Monday morning the U.S. Supreme Court announced that it will convene more than five hours of hearings on the individual mandate portion of the act. Monday afternoon it was business as usual at the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, as a trio of heavy hitters announced a competition to award millions of dollars in grants, courtesy of the ACA, to innovators who help improve healthcare and lower costs.

Then Tuesday morning the Optum Institute opened its doors with the mission to help kick-start what it calls sustainable health communities. Think of the ACA's accountable care organizations but without all the rules. The communities even have their own version of Don Berwick's infamous triple aim: increase the quality of care, improve patient experience, and lower overall healthcare costs. (Disclosure: OptumInsight, a sister company within UnitedHealth Group, advertises with HealthLeaders Media.)

Carol Simon, PhD, who has been tapped to lead the Optum Institute, says that similar to CMS, it aims to provide thought leadership to providers, payers, employers, governments, and even consumers as healthcare undergoes the changes introduced in the ACA. She hopes that the institute will become something of a clearinghouse for innovation so that ideas can be shared and implemented among stakeholders. The question the Optum Institute hopes to help stakeholders answer is: How do you change?

The opening of the Optum Institute seems to provide further evidence that despite the political and judicial naysayers, the healthcare industry, while not exactly greeting reform with open arms, sees the value in redesigning our healthcare delivery system to include ACA fundamentals such as integrated and coordinated care. Private industry just wants to set its own course to achieve the triple aim.

Case in point: The development of commercial ACOs. In an earlier column, I wrote about how health plans are creating alliances and partnerships and setting their own rules for meeting quality standards, cutting costs, and earning bonus payments. The commercial ACOs aren't limited to hospital and physician teams either. They include all types of configurations?health plans and physicians, health plans and hospitals, physicians and physicians, and hospital systems and hospital systems.